HB985 - Relating to hospital-owned outpatient facilities, including site-neutral reimbursement rates under Medicaid.

      By: Harrison H.B. No. 985       A BILL TO BE ENTITLED   AN ACT   relating to hospital-owned outpatient facilities, including   site-neutral reimbursement rates under Medicaid.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter A, Chapter 311, Health and Safety   Code, is amended by adding Section 311.006 to read as follows:           Sec.   311.006.     ACQUISITION OF OUTPATIENT HEALTH CARE   FACILITIES. (a) In this section:                 (1)     "Commission" means the Health and Human Services   Commission.                 (2)  "Hospital" means a hospital licensed under Chapter   241.           (b)     A hospital that acquires an outpatient health care   facility shall provide written notice of the acquisition to the   office of the attorney general and the commission.          SECTION 2.  Subchapter B, Chapter 32, Human Resources Code,   is amended by adding Section 32.0286 to read as follows:           Sec.   32.0286.     SITE-NEUTRAL REIMBURSEMENT RATE FOR   OUTPATIENT SERVICES. (a) In this section, "hospital-owned   outpatient facility" means a department, unit, clinic, or other   facility or organization that a hospital provider either creates or   acquires for the purpose of furnishing outpatient services. The   term includes a hospital outpatient department.           (b)     Notwithstanding any other law, the commission shall   ensure the Medicaid reimbursement rate for outpatient services   provided by a hospital-owned outpatient facility is the same as the   reimbursement rate for outpatient services an independent,   physician-owned practice provides if:                 (1)     the outpatient services are not dependent on   technology associated with the facility; and                 (2)     evidence-based rationale does not support a   different reimbursement rate for a specific outpatient service.          SECTION 3.  (a) In this section:                (1)  "Commission" means the Health and Human Services   Commission.                (2)  "Department" means the Texas Department of   Insurance.                (3)  "Medicaid" means the medical assistance program   established under Chapter 32, Human Resources Code.          (b)  The department, in consultation with the commission and   the office of the attorney general, shall conduct a study on the   feasibility and advisability of expanding the policy under Section   32.0286, Human Resources Code, as added by this Act, to commercial   health benefit plan issuers in this state by prohibiting the   issuers from providing provider-based billing rates for outpatient   services that are greater than the rates provided to independent,   physician-owned practices providing the same outpatient services.          (c)  Not later than September 1, 2026, the department shall   prepare and submit to the legislature and the standing committees   of the legislature with primary jurisdiction over insurance and   Medicaid a report containing the results of the study conducted   under Subsection (b) of this section and any recommendations for   legislative or other action. The report must include an estimate of   any projected cost savings to health care consumers in this state   that would result from commercial health benefit plan issuers   implementing a site-neutral payment policy for outpatient   services.          SECTION 4.  Not later than January 1, 2026, the executive   commissioner of the Health and Human Services Commission shall   adopt or amend rules as necessary to comply with Section 32.0286,   Human Resources Code, as added by this Act.          SECTION 5.  Section 311.006, Health and Safety Code, as   added by this Act, applies only to a hospital's acquisition of an   outpatient facility on or after the effective date of this Act.          SECTION 6.  If before implementing any provision of this Act   a state agency determines that a waiver or authorization from a   federal agency is necessary for implementation of that provision,   the agency affected by the provision shall request the waiver or   authorization and may delay implementing that provision until the   waiver or authorization is granted.          SECTION 7.  This Act takes effect September 1, 2025.